The aim of this proposal is a comprehensive 5-yr plan for an NIH Pathway to Independence Award for CANDIDATE, Trenna L. Sutcliffe MD MSc MS, Instructor in the Division of Neonatal and Developmental Medicine at Stanford University School of Medicine. Her long-term career goal as a developmental pediatrician is to become an independent translational researcher whose contributions optimize motor development and learning in children with cerebral palsy (CP), the most common physical disability of childhood. Her current objectives are: 1) understand the neural basis of normal motor development; 2) explain patterns of altered motor development based on patterns of neural injury; 3) evaluate innovative treatments that promote neural plasticity. To accomplish these objectives she will receive didactic, clinical, and experimental training and mentoring in: 1) the neural theories and computational modeling of motor learning and development; and 2) the use of innovative neuroimaging techniques to understand contributions of the neural substrate to motor learning in children with neural injury. These newly acquired skills will allow her to contribute effectively to the disciplines of pediatrics, child development, neuroimaging, and neuroscience. Stanford provides a rich ENVIRONMENT with a strong commitment to mentoring young investigators and supportive faculty to assist with the candidate's goals. Dr. Heidi M. Feldman, a internationally recognized expert in child development, will mentor the candidate. Drs. James L. McClelland, Michael E. Moseley, Allan L. Reiss, and Terence D. Sanger, all distinguished scientists in their fields, will serve as Co-Mentors. The RESEARCH proposal will evaluate pediatric constraint-induced (Cl) movement therapy, a highly promising intervention to reduce long-term disability. The SPECIFIC AIMS are the following: In children with CP, we will: 1) establish that Cl with weekly one-on-one occupational therapy and a home program leads to improved hand use; 2) characterize patterns of improvement after Cl; and 3) determine contributions of young age, presence of developmental disregard, and cerebral white matter integrity to improved function after Cl. This study fulfills a well-described need to research pediatric Cl. Study results will: 1) provide clinical programs with a feasible, economical and effective approach to Cl therapy; 2) improve clinical management based on pattern of improved skills; and 3) determine which subgroup of children benefits from Cl. The study's significance not only goes beyond clinical relevance to provide theoretical insights into mechanisms of action in Cl and will advance the science of motor learning; but also will contribute to the ultimate goal that children with CP can achieve their full potential for healthy and productive lives with decreased disease and disability. [unreadable] [unreadable] [unreadable]